AB0770 Treatment of ankylosing spondylitis (AS) within 1 year after delivery.
Authors: O. Krichevskaya, E. Ilinykh, T. Dubinina, S. Glukhova, A. Demina, I. Andrianova
Journal: Annals of the Rheumatic Diseases (2022)

Background Prescribing therapy to women after childbirth is still a difficult task in Russia due to the well-established ideas among patients and pediatricians of the incompatibility of lactation and treatment. Monitoring AS activity in patients without lactation is also important: maintaining physical and mental health are necessary for full-fledged care of the newborn and the joy of motherhood. Objectives To describe the frequency of drug use in women with AS within 1 year after childbirth, to determine the relationship with AS activity, to compare the incidence of diseases in children under one year whose mothers received and did not receive AS therapy during breastfeeding. Methods 44 pts with confirmed AS (modified New York criteria, 1984) were followed within 1 year after childbirth. The average age of the pts was 32,5 ± 5,8 years. BASDAI at 1, 6 and 12 months after delivery was: 2,4 [1,4;4,2]; 2,6 [1,4; 4,4]; 2,7 [1,5; 4,1], respectively. ASDAS-CPR was: 2,0 [1,2; 2,7]; 1,9 [1,4; 2,5]; 1,7[1,3; 2,3], respectively. AS activity in pts with and without lactation did not differ. 41 pts (93,2%) had been continuing lactation during 1 month after delivery, 27 (61,4%) pts – during 1 month after delivery, 17 (38,6%) pts – during 1 month. Adherence to nonsteroidal anti-inflammatory drugs (NSAID) therapy was defined as the ratio of the actual dose taken to the prescribed dose. The total dose of NSAIDs was determined by the NSAID intake index (M. Dougados, 2001). Results NSAIDs. Ibuprofen was the drug of choice in pts with lactation, 51,2%, 74,1% and 88,2% of pts received it after 1, 6 and 12 months after delivery. Women without lactation received various NSAIDs in 100% of cases. The index of NSAID intake in pts with lactation increased during the first six months after delivery and after 1, 6 and 12 months after delivery and was 0 [0; 25], 33,3 [12; 42,1] and 33,3 [17; 50], respectively (p &lt; 0,05 compared to 1 month after delivery). The index of NSAID intake at 1 and 12 months after delivery in pts without lactation was higher than in pts with lactation (p &lt; 0,05). Adherence to NSAID therapy in pts with lactation increased during follow-up and after 1, 6 and 12 months after delivery was 10 [0; 100], 71 [30; 100] and 100 [50; 100], respectively (p &lt; 0,05 compared to 1 month after delivery). There was no effect of NSAIDs intake on the AS activity. Sulfasalazine (SSZ) because of arthritis in the 3rd trimester of pregnancy was received by 5 pts (11,4%); 2 of them independently canceled SSZ after childbirth due to fear of its negative effect on the baby during breastfeeding, both had recurrent arthritis within a year after childbirth. Against the background of lactation, only 1 woman received SSZ at a dose of 1,5 g per day. bDMARD. During the year after childbirth, 17 (38,6%) pts had a need for bDMARD, however, for insufficient availability only 11 pts (25%) received bDMARD: 1 (certolizumab pegol, CZP) within 1 month after childbirth, 8 (CZP– 4, ADA – 4) within 2 – 6 months, 11 (CZP – 4, adalimumab – 4, infliximab – 1, golimumab – 1, etanercept – 1) within 7 – 12 months. Of these, 4 pts (all pf them intake CZP) received TNF inhibitors during lactation. AS activity in pts with and without lactation on the background of iTNF-alpha therapy did not differ. There was a clear trend of AS activity decreasing against the background of iTNF therapy: ASDACRP 6 and 12 months after delivery was 2,7 ± 0,6 and 2,4 ± 0,5, respectively. In pts with lactation, the same trend was noted: ASDACRP was 2,8 ± 0,5 and 2,1 ± 0,3, respectively. There were no differences in the frequency of acute respiratory viral infections, atopic dermatitis, the need for antibiotics, and the frequency of hospitalizations in breastfed children whose mothers received and did not receive AS therapy during lactation. Conclusion NSAIDs in low doses do not affect AS activity. According to our data performed on a small group of patients with AS, the effectiveness of TNF-alpha therapy does not differ against the background of lactation and without it. It is necessary to increase the knowledge of patients and pediatricians about therapeutic possibilities during lactation to avoid unjustified drug cancellation. Disclosure of Interests None declared